CN104769597A - Apparatus and method for monitoring the treatment of a patient - Google Patents

Apparatus and method for monitoring the treatment of a patient Download PDF

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Publication number
CN104769597A
CN104769597A CN201380058553.6A CN201380058553A CN104769597A CN 104769597 A CN104769597 A CN 104769597A CN 201380058553 A CN201380058553 A CN 201380058553A CN 104769597 A CN104769597 A CN 104769597A
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China
Prior art keywords
treatment
patient
data
unit
relevant
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CN201380058553.6A
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Chinese (zh)
Inventor
P.丹尼尔
M.格雷费
M.卢考
H.施泰尔
K.沃尔夫
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Fresenius Medical Care Deutschland GmbH
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Fresenius Medical Care Deutschland GmbH
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Publication of CN104769597A publication Critical patent/CN104769597A/en
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    • GPHYSICS
    • G16INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16HHEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/63ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation
    • GPHYSICS
    • G16INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16HHEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/67ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for remote operation

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Business, Economics & Management (AREA)
  • General Business, Economics & Management (AREA)
  • Epidemiology (AREA)
  • General Health & Medical Sciences (AREA)
  • Primary Health Care (AREA)
  • Public Health (AREA)
  • External Artificial Organs (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)

Abstract

The invention relates to a method for monitoring the treatment of a patient in the domestic environment of the latter, comprising the following steps: providing (201) treatment-based data to a domestic treatment unit, transmitting (202) the treatment-based data from the treatment unit to a remote monitoring unit in order to monitor the treatment, analyzing the treatment-based data with regard to an ideal or normal state or to treatment success by means of the monitoring unit (203), determining a deviation from an ideal or normal state (208), requesting (204) further treatment-based data from the domestic treatment station in relation to the deviation determined, providing the further treatment-based data (205), and transmitting the further treatment-based data to the monitoring unit (206).

Description

For monitoring equipment and the method for the treatment of patient
Technical field
The present invention relates to the field of the treatment of patient in its home environment.
Background technology
Except patient is in clinic, when the patient that the external guarantee for the treatment of in hospital or general hospital especially suffers from chronic diseases, the treatment of patient in its home environment obtains and has the meaning determined.
This patient exemplarily enumerating chronic kidney failure in dialysis, the guarantee especially in haemodialysis and peritoneal dialysis.
When haemodialysis, blood continues to extract extracorporal circulatory system from patient, is guided and again inject patient by haemodialyser.The mass exchange being similar to kidney is performed at this.Haemodialyser comprises two chambers separated by semipermeable film, and one of them is by blood and another is by bodies for purifying fluids-dialysis fluid-flow through.The haemodialyser of business has the tension of hollow fiber mostly to this, its wall is semi permeable for the material exchanged.Blood is guided by the inner space of hollow fiber, simultaneously dialysis fluid on the direction of usual convection current in the fibre between conveying and drawing away in space.
Dialysis fluid has blood contents matter as electrolytical concentration, and it roughly corresponds to those in Healthy People, and corresponding concentration can remain on normal level in blood thus.The material such as creatinine or urea that will be separated from blood do not comprise dialysis fluid, and this is only because the concentration gradient at film place is separated from blood by diffusion thus.By means of pressure gradient, the water that blood is excessive is got rid of by convection current or ultrafiltration.
Use haemodialysis equipment to control this process, it also guarantees the configuration product of the dialysis fluid be made up of water and concentrate with correct constituent and temperature mostly.This fluid in present filtering device for blood dialysis also for, balance by improving the blood purification (blood filtering) that causes of convection current.During hemodialysis, extract a large amount of ultrafiltrate out to the blood of patient when hemodiafiltration by haemodialyser, it is again substituted by displacement fluid until the Fluid Volume that altogether will extract out.In the modem devices being used for the treatment of chronic renal failure, use online clean dialysis fluid for this reason, its mode be the pipeline of dialysis fluid loop branches is provided with one or more filtration grade and with the adverse current of extracorporeal circulation of blood haemodialyser and/or following current be connected.The additional dialysis fluid filtered adds in blood circulation and is called dilution.
As in dialysis in the heart with haemodialysis equipment treatment patient alternative, the treatment of patient in its home environment has certain meaning, is exactly so-called HHD.This can be undertaken by trained personnel, and as by training dialysis nurse, or patient or its family members are for performing dialysis treatment.
As the dialysis treatment of other types, peritoneal dialysis is also very popular, and wherein create manually entering of the abdominal space of patient, by aseptic, pyrogen-free dialysis fluid is injected in abdominal space.Nature dialyzer is used as, by it because the poisonous uremic metabolin of concentration gradient and different ions are transferred in dialysis fluid by the blood vessel of patient at this peritonaeum film.Simultaneously water is transferred in peritonaeum due to infiltrative gradient.Dialysis fluid is separated in different circulations, abandons and replaces, its according to predetermined pattern each other sequentially by patient or automatically controlled by peritoneal dialysis machine.Perform in home area when peritoneal dialysis, so-called home peritoneal dialysis is widely current.
Not only when HHD but also when home peritoneal dialysis, patient with regular interval, such as, applies for dialysis center with the interval in 4-6 week.Be to improve in corresponding time monitoring patient in family between visit in the heart in this task of the present invention.
Summary of the invention
This task is by treating patient for basis such as the method in claim 1 and 3 as described in any one monitors, especially the method for patient in family solves.In addition this task is by monitor unit as claimed in claim 13, and is solved by computer program as claimed in claim 15.Favourable embodiment provides in the dependent claims.
Accompanying drawing explanation
Other details of the present invention and advantage are explained in more detail according to embodiment illustrated in the accompanying drawings.
Wherein:
Fig. 1 illustrates the calcspar of the surveillance with treatment unit and monitor unit
Fig. 2 illustrates the process flow diagram for monitoring patient's especially the first method of the treatment of patient in family
Fig. 3 illustrates for monitoring patient, the process flow diagram of the other method of the especially treatment of patient in family
Fig. 4 illustrates the block diagram of monitor unit.
Embodiment
Schematically show the patient for monitoring in its home environment in FIG, in other words: the surveillance 100 of patient in family.Surveillance 100 has at least one, in some embodiments multiple are used for the treatment of the treatment unit 102 of the patient in its corresponding home environment, or in other words home treatment unit.For simplicity only one family treatment unit 102 shown in Figure 1.The embodiment of home treatment unit 102 is home dialysis machines, as: HHD machine or home peritoneal dialysis machine.
The data source 101 of data source 101 or the data relevant with treatment that home treatment unit has the relevant data for the treatment of is connected.
The possible embodiment for the treatment of the data source 101 of relevant data is blood glucose measuring devices, blood pressure measuring device, patient's scale or fluid management system or the system for the excess moisture or exsiccosis that obtain patient.The latter can as the balance by setting up the fluid imported and derive when dialysis treatment, and the fluid balance as this treatment realizes.Alternatively or additionally obtain fluid state can based on such as by means of bio-impedance measurement method before treatment or the determination of body composition carried out of period.For determining that the example of this system of excess moisture or lack of water is the body composition monitor issued by applicant.
Other examples being used for the treatment of the data source 101 of relevant data are data input devices, this data input device be used for the described equipment of artificial input measurement data or as the measurement data about the some drugs of patient, or about the measurement data of the consumer (dialyzer as used during hemodialysis) used when treating.When last, data source can also by bar code scanner for scanning corresponding bar code.
Other data sources 102 of the relevant data for the treatment of are provided to relate to the consumption of the dialysis apparatus of use when dialysing, as electric current or water consumption, or the state of the water used, as the state of the malfunction or disinfection that comprise inverse osmosis device.
Data source can 101 be integrated in treatment unit 102, or separated.It can also by conventional personal computer or by conventional mobile phone, smart phone or such as its class work in the latter case, as long as there is corresponding interface, as blue tooth interface in treatment unit.
The video camera as exiting position for detected catheter can also be implemented as data source when treatment unit at peritoneal dialysis machine.
In addition treat unit 102 by home gateway 103 have transmission network 104 connection and from transmission network to monitor unit 105 connection.
Transmission network 104 can comprise the part of disclosed internet, is wherein provided with the interface of the hospital network closed, is integrated with assessment unit 105 in hospital network.
Monitor unit 105 can realize on a computer or in a distributed manner on multiple computers.
Treatment unit 102 and monitor unit 105 form 104 jointly for monitoring the surveillance of patient in family.
Treatment unit 102 can comprise data-reading unit 122 or coupled, for reading the identification data of patient in family from recognition device (card reader as the patient data for reading patient card 121).
In order to be monitored the patient treated with treatment unit 102 by monitor unit 105, composition graphs 2 and 3 represents the method for monitoring patient in family and the connected message respectively between treatment unit 102 and monitor unit 105.
The method of the treatment for monitoring patient 200 represented in fig. 2 provides in step 201 treats relevant data to family's monitor unit.This can occur in the context of the treatment of the supervision patient in family carried out, as occurred in the context of the supervision dialysis treatment carried out.
Usually carry out identifying in the beginning for the treatment of, wherein read patient data with data-reading unit 122 from patient identification device 121 and be transferred to monitor unit 105.The identification of patient can be used in monitor unit the certification comprised or to the authentication ' unit 151 that it distributes.
In the context of this supervision carried out for the treatment of the dialysis dosage Kt/V that so determines or the ultrafiltration volume determined reach can according to treatment time or in the end for the treatment of as the relevant data acquisition for the treatment of.Other enforcements for the treatment of relevant data are the data extracted in the beginning for the treatment of or period, and it represents the body composition of patient, use bio-impedance measurement method extraction as passed through.Other embodiments for the treatment of relevant data are as the beginning respectively in treatment, period or the temperature or the blood pressure that terminate the rear patient extracted, or conduit exits the image of position.
In transmitting step 202, treating relevant data being transferred to long-range monitor unit 105 for monitoring treatment from treatment unit 101.
There is provided reference data for the relevant data for the treatment of, it represents the ideal for the treatment of or carries out without deterioration, the unobtrusive state of patient in family, or expects the consistance of result for the treatment of or treatment and treatment governing principle (Behandlungsrichtlinien).This can such as be realized by monitor unit 105.When monitor unit 105 is parts of hospital network or hospital information system, treatment governing principle so can be used to be used for the treatment of patient in family, to use during this external treatment hospital patient of this treatment governing principle.Reference data can patient provide separately or applicable equally for all patients.Reference data is selected according to the patient identification data of precedent transmission in the first case.
Treat relevant data in monitor unit 105 in analytical procedure 203 in view of perfect condition or normal condition or in view of result for the treatment of analysis to determine and the possible deviation of perfect condition or normal condition, or to determine, the result for the treatment of whether determined.
The analysis for the treatment of relevant data can comprise the time series analysis of such as treating relevant data.So can setting example as the reference profile (Referenzprofil) for hemodialysis, as the reference profile t/V that ultrafiltration profile or the urea that will be obtained by treatment process are removed.That treats relevant data and corresponding reference data in this case compares the comparison that can be included in point of corresponding reference time.
Other example blood pressures of reference data, body temperature, fat constituent, the reference value of water constituent or other reference values of body composition.
Time series analysis can comprise trend analysis in this case, as being convenient to determine, blood pressure, body temperature, or under whether the change of body composition be in the trend determined.
The deviation with the perfect condition represented by one or more reference value or normal condition is determined in the treatment step 208 that monitor unit 105 performs.
So can obtain the message (it has the state of patient in family) about corresponding progress by this way, as the septicemia of development, the excess moisture significantly increased, remarkable change of body composition etc.
Really fix on this with the deviation of perfect condition or normal condition can realize by this way, the symptomatic picture (Symptombild) it being assigned to determine, as moisture in released souls from purgatory, septicemia, blood pressure etc.
As the data of asking other treatment relevant to home treatment unit 201 with the response monitor unit request message 204 of the deviation of the determination of perfect condition or normal condition of the relevant data for the treatment of.Can realize according to the symptomatic picture previously determined in the selection of the relevant data of this other treatment.
The request of the data that treatment is in addition relevant can so realize, and makes request message comprise indicator: which kind of type is the relevant data for the treatment of in addition can be.The type of the data that treatment is in addition relevant can realize according to the deviation previously determined and/or symptomatic picture at this.
As when the temperature determined rises by multiple treatment at peritoneal dialysis patient so the septicemia of identifiable design development possibility and in order to confirm that this suspicion request conduit exits the shooting of position.
The data that the relevant data of the treatment of original transmission are relevant with other treatment be connected to this usually like this, the initial suspicion that the analysis based on the relevant data of the treatment provided at first is set up is by the relevant data confirmation of other treatment or do not have.
Therefore the data of original transmission can also be the view data that conduit exits position, and view data bears automated image analysis, exit the feature of the form parameter of position and the contrast with reference value thereof for obtaining conduit.Because then the deviation of the determination of exemplary reference shape asks temperature survey.
Another example is the runny trend determined based on fluid balance of patient in family, in order to its authorization request biological impedance, for the body composition determining the hydrogenated state comprising patient in family.
The relevant data for the treatment of in addition can also be the answers of the problem of state for patient, and its kind based on the deviation of the determination located patient is selected.
Therefore can send coupling based on the deviation of the determination of the blood pressure of patient in family and be used for the problem catalogue of the symptomatic picture of hypertensive patient to treatment unit 102.
Other problems catalogue can be provided for other symptomatic picture.
In treatment unit 102, in image pickup step 205, realize providing of the relevant data of other treatment, transmit the relevant data of other treatment subsequently to monitor unit 105.
Thering is provided of relevant data is provided and can comprises the expression by means of the I/O unit for the treatment of unit 101 at patient in family place of problem catalogue, and by the input of patient in family to the answer of problem.Alternatively or additionally patient in family requires for performing other measurement by the input-output apparatus for the treatment of unit 102, wherein treats providing of relevant data and is then realized by the above-mentioned data source of use.
The relevant data for the treatment of in addition are then transferred to monitor unit 105 from treatment unit 102 and transmit in transmission message 206.
Then in monitor unit, usually realize the other analysis 209 of the relevant data of the initial treatment obtained together with the relevant data of other treatment, it has target, whether confirms the deviation with the determination of desirable or normal condition.
The common analysis 209 that the relevant data data relevant with other treatment are treated in initial transmission can also realize in like fashion, it is realized for multiple patient, wherein implementation value numeral or right of priority distribution and provide about intervention necessity and/or care-giver check that the necessity for the treatment of and/or care-giver check the seriousness of the necessity determining patient or the deviation determined or the right of priority of symptomatic picture.
Being distributed in this and can realizing by this way of value numeral or right of priority, the distribution to the symptomatic picture determined first carried out is made to take corresponding assessment algorithm, the common analysis of the data that the relevant data of the treatment transmitted at first according to this algorithm realization are relevant with other treatment.
Therefore assessment algorithm can be selected as the symptomatic picture for septicemia, and the common assessment of view data and temperature data that this algorithm exits position according to conduit is determined the seriousness that septicemia exists or risk and is distributed analog value numeral or right of priority.
Other algorithms can be selected for runny symptomatic picture, this algorithm based on fluid balance, the assessment of weight measurement and/or body composition.
Represent the method for monitoring the multiple treatments of patient 300 in its corresponding home environment in figure 3, wherein multiple home treatment unit 101, provides the relevant data for the treatment of as illustrated in step 301 regularly and transmits 302 to central monitoring unit 105.Treating relevant data at this can be the data obtained by means of the data source described together with Fig. 1.Treat relevant packet containing the identification of punishing the patient treated accordingly at treatment unit 101.Method described in figure 3 advantageously can perform together with method described in fig. 2.
In central monitoring unit 105 in analytical procedure 303 in view of relevant data are treated in corresponding perfect condition or normal condition or result for the treatment of analysis, wherein to the identification Dispatching Priority 304 of the patient for the treatment of, right of priority provides intervention necessity, and/or care-giver checks the seriousness of the necessity that the necessity for the treatment of and/or care-giver check the care-giver of patient or the deviation determined or symptomatic picture.This is external can consider other standards to when patient's Dispatching Priority, as immediate check data etc. according to plan.
In ensuing step display 305 on the output device of monitor unit 105 by this way to the result of care-giver's step display 304, make the notice of care-giver to be led the patient determined according to the right of priority of assigning.
To this can indication example as patient list, wherein patient is according to the order of priority of distributing, it can give color code and use when representing patient data maybe can select other representations, wherein preferably guarantee, the notice of care-giver preferably leads patient, comparatively early intervention necessity is provided to this patient, and/or care-giver check treatment and/or care-giver check that the seriousness of the necessity of patient or the deviation determined for this patient or symptomatic picture is more remarkable.
Fig. 4 represents the structure of the monitor unit 151 of the treatment for monitoring patient.Monitor unit 151 have corresponding to above other together with at the interface 402 for receive treatment relevant data of Fig. 2 with 3 methods represented.In addition monitor unit 151 have corresponding to Fig. 2 with 3 the processing unit 401 of the data relevant for the treatment for the treatment of of one of method, and for exporting the output unit 403 of the information of care-giver in the context together with method described in Fig. 3.In addition preferably monitor unit 151 has for performing for based at patient identification device, as the authentication module 151 of the method for data identification that patient card stores and/or certification patient.

Claims (15)

1., for monitoring a method for the treatment of patient in its home environment, described method comprises the following step:
(201) are provided to treat relevant data to home treatment unit,
By data relevant for treatment from treatment unit transmission (202) to the long-range monitor unit for monitoring treatment,
The relevant data for the treatment of are analyzed by monitor unit (203) in view of perfect condition or normal condition or in view of result for the treatment of,
Determine the deviation with perfect condition or normal condition (208),
From family therapy place about the data that the treatment that the deviation request (204) determined is other is relevant,
The data (205) providing other treatment relevant, and
Transmit the relevant data of other treatment to monitor unit (206).
2. the method for claim 1, wherein determines to comprise with the step of the deviation of perfect condition or normal condition (203) distribution of the symptomatic picture determined and wherein carries out the request of the relevant data of other treatment according to the symptomatic picture determined.
3. one kind for monitoring the method for the multiple treatments of patient in its corresponding home environment, described method comprises the following step: provide from multiple home treatment unit (201, 301) data that multiple treatments are relevant, in view of corresponding perfect condition or normal condition or result for the treatment of analyze multiple data relevant with treatment by monitor unit (303), check that treatment and/or care-giver check the necessity Dispatching Priority (304) of patient about intervention necessity and/or care-giver, according to the right of priority of assigning, the notice of care-giver (305) is guided to the patient determined.
4. for about intervening that necessity and/or care-giver check treatment and/or care-giver, the method according to any one of claim 2 and claim 3, wherein checks that the assignment of the necessity right of priority of patient realizes by using the assessment algorithm determined according to symptomatic picture.
5. the method for the treatment monitoring patient as described in claim 3 or 4 comprises the following step: use expert system for analyzing the relevant data of multiple treatment.
6. the method according to any one of the preceding claims, wherein provides the relevant data for the treatment of and the analysis of wherein treating relevant data comprises time series analysis at multiple time point.
7. the method according to any one of the preceding claims, wherein monitor unit (105) is the part of hospital information system, wherein arrange the authenticate device (151) of the patient determined for certification or the care-giver determined, described method comprises the following step:
Treatment unit (102) is used to come from reading verify data for the authenticate device of certification patient or care-giver and based on the verify data certification patient read hospital information system.
8. the method according to any one of the preceding claims, wherein treating unit (102) is haemodialysis equipment, preferably haemodialysis control unit or peritoneal dialysis machine.
9. method as claimed in claim 8, wherein monitor unit (105) is the part of hospital information system, the governing principle with expectation target of the peritoneal dialysis treatment that wherein maybe will perform for the hemodialysis that will perform is filed as one or more data record, wherein in view of the deviation of the expectation target with governing principle carries out the analysis for the treatment of relevant data.
10. as claimed in claim 8 or 9 method, from following list, wherein select the relevant data for the treatment of or the relevant data of additional treatment:
-dialysis dosage,
-ultrafiltration volume
-bioimpedance data, comprises the body composition and/or excess moisture determined by means of bioimpedance data
-blood pressure,
The body temperature of-patient,
-conduit enters and exits the view data of position
-patient weight.
11. methods as claimed in claim 10, the analysis that wherein conduit entered and exited the view data of position comprises the automated graphics process of view data.
12. the method according to any one of the preceding claims, wherein treat the user's input for the user interface place for the treatment of unit of relevant data or the relevant data source of additional treatment, and wherein user's input relate to the answer of the problem to patient.
13. 1 kinds for monitoring the monitor unit (105) of the treatment of patient in its home environment, comprise: for receiving the interface (402) of the relevant data for the treatment of from treatment unit, output unit (403), and processing unit (401), its adaptation is for performing the method according to any one of claim 1-12.
14. 1 kinds, for monitoring the surveillance (100) of patient in the treatment of treatments period in its home environment, comprise: be used for the treatment of the treatment unit (102) of patient and monitor unit (105) as claimed in claim 13.
15. 1 kinds of computer programs, comprise program code sections, and its adaptive being used for performs method according to any one of claim 1-12.
CN201380058553.6A 2012-11-08 2013-11-06 Apparatus and method for monitoring the treatment of a patient Pending CN104769597A (en)

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US201261723978P 2012-11-08 2012-11-08
US61/723978 2012-11-08
DE102012021805.2A DE102012021805A1 (en) 2012-11-08 2012-11-08 Apparatus and method for monitoring the treatment of a patient
DE102012021805.2 2012-11-08
PCT/EP2013/003328 WO2014072043A1 (en) 2012-11-08 2013-11-06 Apparatus and method for monitoring the treatment of a patient

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EP (1) EP2917855A1 (en)
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AU (2) AU2013343934A1 (en)
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DE (1) DE102012021805A1 (en)
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